{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T23:12:59Z","timestamp":1769728379169,"version":"3.49.0"},"reference-count":62,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"20","license":[{"start":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T00:00:00Z","timestamp":1763337600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2025,11,17]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>A duplicated middle cerebral artery (DMCA) is a rare variant of the middle cerebral artery (MCA), arising between the anterior choroidal artery and distal end of the internal carotid artery. Despite its rarity, DMCA is clinically significant due to its association with aneurysm formation and high risk of rupture. No case of oculomotor nerve palsy related to DMCA aneurysm has been reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 49-year-old woman presented with sudden severe headache (Hunt and Kosnik grade III) and left pupil dilation. Imaging showed a diffuse, left predominant subarachnoid hemorrhage and four aneurysms. Based on the hematoma location and clinical findings, the left DMCA aneurysm was suspected as the rupture point. She underwent left frontotemporal craniotomy with clipping of three aneurysms. Intraoperative evaluation revealed that the DMCA was displaced by perianeurysmal hematoma, compressing the left oculomotor nerve. After aneurysmal neck clipping, removal of the hematoma surrounding the DMCA was performed. Her postoperative course was uneventful and left pupillary dilation returned to normal within a few days postoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>This case demonstrates that a hematoma from a ruptured DMCA aneurysm can displace the DMCA and cause oculomotor nerve palsy. Hence, DMCA aneurysm should be recognized as one of the possible causes of oculomotor nerve palsy.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/abs\/10.3171\/CASE25651\">https:\/\/thejns.org\/doi\/abs\/10.3171\/CASE25651<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25651","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T11:09:32Z","timestamp":1769684972000},"source":"Crossref","is-referenced-by-count":0,"title":["Oculomotor nerve palsy caused by arterial displacement due to subarachnoid hemorrhage from a ruptured duplicated middle cerebral artery aneurysm: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"given":"Yuta","family":"Koketsu","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9251-4230","authenticated-orcid":true,"given":"Takafumi","family":"Tanei","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaki","family":"Sumitomo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Toyota Kosei Hospital, Toyota, Aichi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akino","family":"Kawamura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Toyota Kosei Hospital, Toyota, Aichi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eiji","family":"Tachibana","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Toyota Kosei Hospital, Toyota, Aichi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2484-1360","authenticated-orcid":true,"given":"Ryuta","family":"Saito","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"6","key":"bib1","series-title":"Neurol Med Chir (Tokyo)","first-page":"261","article-title":"Anomalies of the middle cerebral artery","volume":"57","author":"Uchiyama","year":"2017","unstructured":"Uchiyama N.Anomalies of the middle cerebral artery. Neurol Med Chir (Tokyo). 2017;57(6):261-266."},{"issue":"1","key":"bib2","series-title":"AJNR Am J Neuroradiol","first-page":"45","article-title":"Middle cerebral artery variations: duplicated and accessory arteries","volume":"19","author":"Komiyama","year":"1998","unstructured":"Komiyama MNakajima HNishikawa MYasui T.Middle cerebral artery variations: duplicated and accessory arteries. AJNR Am J Neuroradiol. 1998;19(1):45-49."},{"issue":"3","key":"bib3","series-title":"Neurol Med Chir (Tokyo)","first-page":"207","article-title":"Intracranial aneurysms associated with the accessory middle cerebral artery and duplication of the middle cerebral artery. Report of two cases","volume":"24","author":"Fuwa","year":"1984","unstructured":"Fuwa IMatsukado YWada H.Intracranial aneurysms associated with the accessory middle cerebral artery and duplication of the middle cerebral artery. Report of two cases. Article in Japanese. Neurol Med Chir (Tokyo). 1984;24(3):207-211."},{"issue":"1","key":"bib4","series-title":"J Med Case Rep","first-page":"283","article-title":"Duplicated middle cerebral artery associated with aneurysm at M1\/M2 bifurcation: a case report","volume":"12","author":"Mori","year":"2018","unstructured":"Mori KTamase ASeki SDuplicated middle cerebral artery associated with aneurysm at M1\/M2 bifurcation: a case report. J Med Case Rep. 2018;12(1):283."},{"issue":"7253","key":"bib5","series-title":"Lancet","first-page":"421","article-title":"The pathology of ruptured middle-cerebral aneurysms with special reference to the differences between the sexes","volume":"2","author":"CROMPTON","year":"1962","unstructured":"CROMPTON MR.The pathology of ruptured middle-cerebral aneurysms with special reference to the differences between the sexes. Lancet. 1962;2(7253):421-425."},{"issue":"3","key":"bib6","series-title":"Am J Roentgenol Radium Ther Nucl Med","first-page":"567","article-title":"Anomalies of the middle cerebral artery: accessory artery, duplication, and early bifurcation","volume":"118","author":"Teal","year":"1973","unstructured":"Teal JSRumbaugh CLBergeron RTSegall HD.Anomalies of the middle cerebral artery: accessory artery, duplication, and early bifurcation. Am J Roentgenol Radium Ther Nucl Med. 1973;118(3):567-575."},{"issue":"2","key":"bib7","series-title":"Surg Neurol","first-page":"190","article-title":"Treatment of unruptured duplicated middle cerebral artery aneurysm: case report","volume":"65","author":"Kai","year":"2006","unstructured":"Kai YHamada JMorioka MYano SKudo MKuratsu J.Treatment of unruptured duplicated middle cerebral artery aneurysm: case report. Surg Neurol. 2006;65(2):190-193."},{"issue":"2","key":"bib8","series-title":"J Korean Neurosurg Soc","first-page":"102","article-title":"Middle cerebral artery duplication: classification and clinical implications","volume":"49","author":"Chang","year":"2011","unstructured":"Chang HYKim MS.Middle cerebral artery duplication: classification and clinical implications. J Korean Neurosurg Soc. 2011;49(2):102-106."},{"key":"bib9","series-title":"Front Neurol","first-page":"845296","article-title":"Case report: \u201cclipping\u201d an internal carotid artery aneurysm with a duplicated middle cerebral artery and the anterior choroidal artery arising from the dome","volume":"13","author":"Otsuka","year":"2022","unstructured":"Otsuka NYajima HMiyawaki SCase report: \u201cclipping\u201d an internal carotid artery aneurysm with a duplicated middle cerebral artery and the anterior choroidal artery arising from the dome. 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World Neurosurg. 2020;143:353-359."},{"issue":"6","key":"bib13","series-title":"No Shinkei Geka","first-page":"515","article-title":"A case of unruptured cerebral aneurysm arising from duplicate origin of the middle cerebral artery","volume":"48","author":"Iwata","year":"2020","unstructured":"Iwata MKawaguchi SManaka H.A case of unruptured cerebral aneurysm arising from duplicate origin of the middle cerebral artery. Article in Japanese. No Shinkei Geka. 2020;48(6):515-520."},{"issue":"1","key":"bib14","series-title":"BMC Neurol","first-page":"3","article-title":"Correlation between multiple cerebral aneurysms and a rare type of segmental duplication of the middle cerebral artery","volume":"20","author":"Stojanovi\u0107","year":"2020","unstructured":"Stojanovi\u0107 NNKosti\u0107 AMiti\u0107 RBerila\u017ei\u0107 L.Correlation between multiple cerebral aneurysms and a rare type of segmental duplication of the middle cerebral artery. BMC Neurol. 2020;20(1):3."},{"issue":"5","key":"bib15","series-title":"J Neuroendovasc Ther","first-page":"183","article-title":"A patient with an unruptured aneurysm in the internal carotid artery-duplicated middle cerebral artery on whom coil embolization with balloon remodeling was performed","volume":"14","author":"Suzuki","year":"2020","unstructured":"Suzuki RTakigawa TAnazawa TA patient with an unruptured aneurysm in the internal carotid artery-duplicated middle cerebral artery on whom coil embolization with balloon remodeling was performed. J Neuroendovasc Ther. 2020;14(5):183-187."},{"issue":"2","key":"bib16","series-title":"Case Rep Neurol","first-page":"446","article-title":"Aneurysm arising at the origin of a duplicated middle cerebral artery","volume":"13","author":"Alliez","year":"2021","unstructured":"Alliez JRManera L.Aneurysm arising at the origin of a duplicated middle cerebral artery. Case Rep Neurol. 2021;13(2):446-450."},{"issue":"3","key":"bib17","series-title":"J Cerebrovasc Endovasc Neurosurg","first-page":"240","article-title":"A case of an unruptured duplicated middle cerebral artery aneurysm\u2014an unusual presentation of the distal internal carotid artery aneurysm","volume":"23","author":"Oh","year":"2021","unstructured":"Oh BKKim YHKim CHLee SWSung SKSong GS.A case of an unruptured duplicated middle cerebral artery aneurysm\u2014an unusual presentation of the distal internal carotid artery aneurysm. J Cerebrovasc Endovasc Neurosurg. 2021;23(3):240-244."},{"issue":"7","key":"bib18","series-title":"J Stroke Cerebrovasc Dis","first-page":"105773","article-title":"Duplicated middle cerebral artery aneurysms treated by coil embolization; A report of two cases and literature review","volume":"30","author":"Fujimoto","year":"2021","unstructured":"Fujimoto KHashimoto HUchiyama YMaekawa HShida YNakagawa I.Duplicated middle cerebral artery aneurysms treated by coil embolization; A report of two cases and literature review. J Stroke Cerebrovasc Dis. 2021;30(7):105773."},{"key":"bib19","series-title":"Surg Neurol Int","first-page":"33","article-title":"Unruptured cerebral aneurysms with the segmental duplicated middle cerebral artery formed a fenestrated structure at origin","volume":"13","author":"Shiozaki","year":"2022","unstructured":"Shiozaki EKawahara IUchida DUnruptured cerebral aneurysms with the segmental duplicated middle cerebral artery formed a fenestrated structure at origin. Surg Neurol Int. 2022;13:33."},{"key":"bib20","series-title":"Interdiscip Neurosurg Adv Tech Case Manag","first-page":"101750","article-title":"Endovascular treatment of anastomotic duplicated middle cerebral artery aneurysm: report of two cases","volume":"32","author":"Matsumoto","year":"2023","unstructured":"Matsumoto YAkamatsu YKojima DEndovascular treatment of anastomotic duplicated middle cerebral artery aneurysm: report of two cases. Interdiscip Neurosurg Adv Tech Case Manag. 2023;32:101750."},{"key":"bib21","series-title":"Surg Neurol Int","first-page":"194","article-title":"Endovascular treatment of unruptured aneurysm arising from duplicate origin of the middle cerebral artery\u2014a case report and literature review","volume":"15","author":"Tanoue","year":"2024","unstructured":"Tanoue NTaniguchi AKubo FEndovascular treatment of unruptured aneurysm arising from duplicate origin of the middle cerebral artery\u2014a case report and literature review. Surg Neurol Int. 2024;15:194."},{"issue":"suppl 21","key":"bib22","series-title":"Surg Neurol Int","first-page":"S549","article-title":"Aneurysm at origin of duplicated middle cerebral artery associated with another aneurysm","volume":"6","author":"Iida","year":"2015","unstructured":"Iida YTamase AKamide TMori KSeki SNomura M.Aneurysm at origin of duplicated middle cerebral artery associated with another aneurysm. Surg Neurol Int. 2015;6(suppl 21):S549-S552."},{"issue":"10","key":"bib23","series-title":"J Neurointerv Surg","first-page":"964","article-title":"Endovascular versus surgical treatment for improvement of oculomotor nerve palsy caused by unruptured posterior communicating artery aneurysms","volume":"12","author":"Signorelli","year":"2020","unstructured":"Signorelli FPop RGanau MEndovascular versus surgical treatment for improvement of oculomotor nerve palsy caused by unruptured posterior communicating artery aneurysms. J Neurointerv Surg. 2020;12(10):964-967."},{"issue":"8","key":"bib24","series-title":"Int J Ophthalmol","first-page":"1316","article-title":"Nomogram model for predicting oculomotor nerve palsy in patients with intracranial aneurysm","volume":"15","author":"Cui","year":"2022","unstructured":"Cui YYWang BJiang BZhao SH.Nomogram model for predicting oculomotor nerve palsy in patients with intracranial aneurysm. Int J Ophthalmol. 2022;15(8):1316-1321."},{"key":"bib25","series-title":"Clin Neurol Neurosurg","first-page":"169","article-title":"Third nerve palsy caused by compression of the posterior communicating artery aneurysm does not depend on the size of the aneurysm, but on the distance between the ICA and the anterior-posterior clinoid process","volume":"123","author":"Anan","year":"2014","unstructured":"Anan MNagai YFudaba HThird nerve palsy caused by compression of the posterior communicating artery aneurysm does not depend on the size of the aneurysm, but on the distance between the ICA and the anterior-posterior clinoid process. Clin Neurol Neurosurg. 2014;123:169-173."},{"key":"bib26","series-title":"Oper Neurosurg","article-title":"Chronic oculomotor nerve palsy presentation from posterior communicating artery aneurysm: a case series","author":"Hung","year":"Published online July 22, 2025. doi:10.1227\/ons.0000000000001718","unstructured":"Hung AYang WJackson CChronic oculomotor nerve palsy presentation from posterior communicating artery aneurysm: a case series. Oper Neurosurg. Published online July 22, 2025. doi:10.1227\/ons.0000000000001718."},{"issue":"3","key":"bib27","series-title":"Acta Neurochir (Wien)","first-page":"813","article-title":"Unilateral oculomotor nerve palsy caused by arterial compression accompanying subarachnoid hemorrhage: a case report","volume":"163","author":"Saito","year":"2021","unstructured":"Saito SHasegawa HTakino TUnilateral oculomotor nerve palsy caused by arterial compression accompanying subarachnoid hemorrhage: a case report. 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Neuroophthalmology. 2019;43(1):53-55."},{"issue":"6","key":"bib1","series-title":"Neurol Med Chir (Tokyo)","first-page":"261","article-title":"Anomalies of the middle cerebral artery","volume":"57","author":"Uchiyama","year":"2017","unstructured":"Uchiyama N.Anomalies of the middle cerebral artery. Neurol Med Chir (Tokyo). 2017;57(6):261-266."},{"issue":"1","key":"bib2","series-title":"AJNR Am J Neuroradiol","first-page":"45","article-title":"Middle cerebral artery variations: duplicated and accessory arteries","volume":"19","author":"Komiyama","year":"1998","unstructured":"Komiyama MNakajima HNishikawa MYasui T.Middle cerebral artery variations: duplicated and accessory arteries. AJNR Am J Neuroradiol. 1998;19(1):45-49."},{"issue":"3","key":"bib3","series-title":"Neurol Med Chir (Tokyo)","first-page":"207","article-title":"Intracranial aneurysms associated with the accessory middle cerebral artery and duplication of the middle cerebral artery. Report of two cases","volume":"24","author":"Fuwa","year":"1984","unstructured":"Fuwa IMatsukado YWada H.Intracranial aneurysms associated with the accessory middle cerebral artery and duplication of the middle cerebral artery. Report of two cases. Article in Japanese. Neurol Med Chir (Tokyo). 1984;24(3):207-211."},{"issue":"1","key":"bib4","series-title":"J Med Case Rep","first-page":"283","article-title":"Duplicated middle cerebral artery associated with aneurysm at M1\/M2 bifurcation: a case report","volume":"12","author":"Mori","year":"2018","unstructured":"Mori KTamase ASeki SDuplicated middle cerebral artery associated with aneurysm at M1\/M2 bifurcation: a case report. J Med Case Rep. 2018;12(1):283."},{"issue":"7253","key":"bib5","series-title":"Lancet","first-page":"421","article-title":"The pathology of ruptured middle-cerebral aneurysms with special reference to the differences between the sexes","volume":"2","author":"CROMPTON","year":"1962","unstructured":"CROMPTON MR.The pathology of ruptured middle-cerebral aneurysms with special reference to the differences between the sexes. Lancet. 1962;2(7253):421-425."},{"issue":"3","key":"bib6","series-title":"Am J Roentgenol Radium Ther Nucl Med","first-page":"567","article-title":"Anomalies of the middle cerebral artery: accessory artery, duplication, and early bifurcation","volume":"118","author":"Teal","year":"1973","unstructured":"Teal JSRumbaugh CLBergeron RTSegall HD.Anomalies of the middle cerebral artery: accessory artery, duplication, and early bifurcation. Am J Roentgenol Radium Ther Nucl Med. 1973;118(3):567-575."},{"issue":"2","key":"bib7","series-title":"Surg Neurol","first-page":"190","article-title":"Treatment of unruptured duplicated middle cerebral artery aneurysm: case report","volume":"65","author":"Kai","year":"2006","unstructured":"Kai YHamada JMorioka MYano SKudo MKuratsu J.Treatment of unruptured duplicated middle cerebral artery aneurysm: case report. Surg Neurol. 2006;65(2):190-193."},{"issue":"2","key":"bib8","series-title":"J Korean Neurosurg Soc","first-page":"102","article-title":"Middle cerebral artery duplication: classification and clinical implications","volume":"49","author":"Chang","year":"2011","unstructured":"Chang HYKim MS.Middle cerebral artery duplication: classification and clinical implications. J Korean Neurosurg Soc. 2011;49(2):102-106."},{"key":"bib9","series-title":"Front Neurol","first-page":"845296","article-title":"Case report: \u201cclipping\u201d an internal carotid artery aneurysm with a duplicated middle cerebral artery and the anterior choroidal artery arising from the dome","volume":"13","author":"Otsuka","year":"2022","unstructured":"Otsuka NYajima HMiyawaki SCase report: \u201cclipping\u201d an internal carotid artery aneurysm with a duplicated middle cerebral artery and the anterior choroidal artery arising from the dome. Front Neurol. 2022;13:845296."},{"issue":"9","key":"bib10","series-title":"Medicein (Baltimore)","first-page":"e9947","article-title":"Duplicated middle cerebral artery origin with an aneurysm","volume":"97","author":"Ren","year":"2018","unstructured":"Ren HMa LWei MLi JYu MYin L.Duplicated middle cerebral artery origin with an aneurysm. 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BMC Neurol. 2020;20(1):3."},{"issue":"5","key":"bib15","series-title":"J Neuroendovasc Ther","first-page":"183","article-title":"A patient with an unruptured aneurysm in the internal carotid artery-duplicated middle cerebral artery on whom coil embolization with balloon remodeling was performed","volume":"14","author":"Suzuki","year":"2020","unstructured":"Suzuki RTakigawa TAnazawa TA patient with an unruptured aneurysm in the internal carotid artery-duplicated middle cerebral artery on whom coil embolization with balloon remodeling was performed. J Neuroendovasc Ther. 2020;14(5):183-187."},{"issue":"2","key":"bib16","series-title":"Case Rep Neurol","first-page":"446","article-title":"Aneurysm arising at the origin of a duplicated middle cerebral artery","volume":"13","author":"Alliez","year":"2021","unstructured":"Alliez JRManera L.Aneurysm arising at the origin of a duplicated middle cerebral artery. Case Rep Neurol. 2021;13(2):446-450."},{"issue":"3","key":"bib17","series-title":"J Cerebrovasc Endovasc Neurosurg","first-page":"240","article-title":"A case of an unruptured duplicated middle cerebral artery aneurysm\u2014an unusual presentation of the distal internal carotid artery aneurysm","volume":"23","author":"Oh","year":"2021","unstructured":"Oh BKKim YHKim CHLee SWSung SKSong GS.A case of an unruptured duplicated middle cerebral artery aneurysm\u2014an unusual presentation of the distal internal carotid artery aneurysm. 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J Neurointerv Surg. 2020;12(10):964-967."},{"issue":"8","key":"bib24","series-title":"Int J Ophthalmol","first-page":"1316","article-title":"Nomogram model for predicting oculomotor nerve palsy in patients with intracranial aneurysm","volume":"15","author":"Cui","year":"2022","unstructured":"Cui YYWang BJiang BZhao SH.Nomogram model for predicting oculomotor nerve palsy in patients with intracranial aneurysm. 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